Provider Demographics
NPI:1063422871
Name:HYATT, PATRICIA (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-1395
Mailing Address - Country:US
Mailing Address - Phone:208-879-6671
Mailing Address - Fax:208-879-6680
Practice Address - Street 1:1050 CLINIC RD N
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226-9376
Practice Address - Country:US
Practice Address - Phone:208-879-6671
Practice Address - Fax:208-879-6680
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist